Question

1. what is the most common site for monitor- ing the pulse rate? (a) apical pulse (b) femoral pulse (c) pedal pulse (d) radial pulse 19. for adults, the normal pulse rate is (a) 40 to 60 beats per minute (b) 60 to 100 beats per minute (c) 90 to 120 beats per minute (d) 20 to 40 beats per minute 20. inhaling air into the lungs is called (a) inspiration (b) expiration (c) rhythm (d) pulse 21. exhaling air out of the lungs is called (a) inspiration (b) expiration (c) rhythm (d) pulse 22. the normal respiration rate for adults ranges from (a) 5 to 10 breaths per minute (b) 12 to 20 breaths per minute (c) 25 to 32 breaths per minute (d) 7 to 11 breaths per minute 23. why is it important for the na to observe respirations without letting the resident know what she is doing? (a) people may breathe more quickly if they know they are being observed. (b) people will hold their breath if they know what an na wants to measure. (c) the procedure takes less time if the resi- dent is unaware of what is happening. (d) observing respirations is a painful process for most people. 24. which of the following is considered a nor- mal blood pressure reading? (a) 110/79 (b) 130/85 (c) 110/80 (d) 120/80 25. which of the following pieces of equipment is used to measure blood pressure? (a) sphygmomanometer (b) reflex hammer (c) otoscope (d) thermometer 26. the second measurement of blood pressure reflects the phase when the heart relaxes. it is called the ____ phase. (a) systolic (b) mercurial (c) hyperbolic (d) diastolic 27. a blood pressure measurement is recorded as a __. (a) rhythm (b) fraction (c) decimal (d) equation 28. in the __ phase of blood pressure, the heart is at work, contracting and pushing blood from the left ventricle of the heart. (a) systolic (b) mercurial (c) hyperbolic (d) diastolic 29. a pulse oximeter measures (a) blood pressure and heart rate (b) blood pressure and pulse rate (c) blood oxygen level and pulse rate (d) blood oxygen level and temperature short answer 30. if a resident complains of pain, what ques- tions may the nurse ask the na to ask the resident to get accurate information? _________________________________ _________________________________ _________________________________ _________________________________ ___________________________________

Explanation:

1. The radial pulse (wrist) is the most accessible and common site for pulse monitoring.
2. Adult normal pulse rate is 60-100 bpm.
3. Inhalation is called inspiration.
4. Exhalation is called expiration.
5. Adult normal respiration rate is 12-20 breaths/min.
6. Awareness of observation can alter breathing (conscious control), so unobserved measurement is accurate.
7. Normal blood pressure is typically 120/80 mmHg (systolic/diastolic).
8. Sphygmomanometer measures blood pressure.
9. Diastolic phase is when the heart relaxes.
10. Blood pressure is recorded as a fraction (systolic/diastolic).
11. Systolic phase is when the heart contracts.
12. Pulse oximeter measures blood oxygen level and pulse rate.
13. Key pain assessment questions include location, intensity, quality, duration, triggers, alleviating factors, and associated symptoms.

Answer:

1. D. Radial pulse
2. B. 60 to 100 beats per minute
3. A. Inspiration
4. B. Expiration
5. B. 12 to 20 breaths per minute
6. A. People may breathe more quickly if they know they are being observed.
7. D. 120/80
8. A. Sphygmomanometer
9. D. Diastolic
10. B. Fraction
11. A. Systolic
12. C. Blood oxygen level and pulse rate
13. Examples: Where is the pain located? On a scale of 1-10, how severe is the pain? What does the pain feel like (e.g., sharp, dull)? When did the pain start? Does anything make the pain better or worse? Are there any other symptoms with the pain?